Understanding malignant transformation of endometriosis: Imaging features with pathologic correlation
Abstract
Purpose Transformation of benign endometriosis to endometriosis-associated ovarian carcinoma (EAOC) is rare; however, women with endometriosis are four times more likely to develop EAOC which can present 20 years earlier than de novo ovarian cancer. Presenting symptoms are often vague and the radiologist's role in recognizing EAOC is critical for early detection and treatment. Histopathologic evaluation remains the mainstay for definitive diagnosis.Methods Using a case-based approach, this article will review the sonographic, CT, and MRI features of EAOC with an emphasis on MRI. Histopathologic correlation of benign and malignant endometriosis will be reviewed.Results Multiple factors contribute to the malignant transformation of endometriosis including genetic alterations, hormonal influences, oxidative stress, and inflammation. Malignancy most often occurs in ovarian endometriomas with less common sites involving the rectovaginal septum, rectosigmoid colon, and abdominal wall scars. The most common pathologic subtypes are endometrioid adenocarcinoma and clear cell carcinoma. MRI is the most specific imaging modality for evaluating EAOC. Key MR features include solid enhancing nodules (accentuated by subtraction imaging), nodular septations, loss of T2 shading within the endometrioma, and diffusion restriction.Conclusions EAOC is a distinct disease that affects women with benign endometriosis at younger ages than classic ovarian cancer. Understanding the imaging features of malignant transformation of endometriosis is essential for early diagnosis and timely definitive treatment.
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Molecular predictors of malignant transformation could exist as genetic alterations, such as mutations in PTEN, ARID1, BAF250a and p53, which have been found in both endometriosis-associated malignancy and endometriosis.
“Lastly, molecular predictors of malignant transformation could exist as genetic alterations, and as a loss of heterozygosity, such as mutations in PTEN, ARID1, BAF250a and p53, which have been found in both endometriosis-associated malignancy and endometriosis [47,48].”
From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [48]
Fibroblast growth factor (FGF-1) and interleukine 1 (IL1) are expressed in both endometriosis and ovarian cancer, suggesting a common mechanism of action towards the malignant transformation.
“Fibroblast growth factor (FGF-1) and interleukine 1 (IL1) are also expressed in both endometriosis and ovarian cancer, suggesting a common mechanism of action towards the malignant transformation [48].”
From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [48]
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Self-citationMalignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review
Alaert, J., Lancelle, M., Timmermans, M., Tanos, P., Nisolle, M., & Karampelas, S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13082282 · Cited by 9 · see citing works
“Fibroblast growth factor (FGF-1) and interleukine 1 (IL1) are also expressed in both endometriosis and ovarian cancer, suggesting a common mechanism of action towards the malignant transformation [48].”
Background
- Authors
- Robinson, K. A., Menias, C. O., Chen, L., Schiappacasse, G., Shaaban, A. M., Caserta, M. P., Elsayes, K. M., VanBuren, W. M., & Bolan, C. W.
- Affiliations
- Mayo Clinic Hospital (US)
- Universidad del Desarrollo (CL)
- University of Utah (US)
- Mayo Clinic in Florida (US)
- The University of Texas MD Anderson Cancer Center (US)
- Mayo Clinic (US)
- Corresponding author
- Robinson, Kristin A.
- ORCID
- Venue
- Abdominal Radiology
- Published
- 2019-04-02
- Volume
- 45
- Issue
- 6
- Pages
- 1762-1775
- ISSN
- 2366-004X (ISSN-L)
- 2366-0058
- OpenAlex
- W2932128083
- Cited by
- 67
- References
- 51
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 11 · 2023: 11 · 2022: 8 · 2021: 5 · 2020: 13 · 2019: 1
- FWCI
- 6.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Abdominal Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- malignant transformation of endometriosis, endometrioma, MRI findings, restricted diffusion, subtraction imaging, endometrioid carcinoma, clear cell carcinoma, histopathological correlation, early detection, ovarian cancer
- MeSH terms
- Cell Transformation, Neoplastic, Endometriosis, Female, Humans, Ovarian Neoplasms, Adenocarcinoma, Clear Cell, Carcinoma, Endometrioid
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